Coffeehouse

Lively debates over a virtual cuppa

Clearing the air on e-cigarettes

“Smokers, if you can use [e-cigarettes] as a tool to quit, do it. Start today.”

Lynn Kozlowski

Professor in the Department of Community Health and Health Behavior in the School of Public Health and Health Professions

E-cigarettes have become one of the most hotly debated public
health issues in recent years. Some say they’re saving lives;
others say they’re dangerous. We sat down with two noted
researchers whose work focuses on cigarettes and health to get
their take.

Lynn
Kozlowski, professor in the Department of Community Health and
Health Behavior in the School of Public Health and Health
Professions, has contributed to four U.S. Surgeon General reports
on smoking and health. Gary
Giovino (PhD ’87, MS ’79) is chair of the
Department of Community Health and Health Behavior and authored the
largest
study on tobacco-use prevalence ever published.

Lynn Kozlowski: If you target messages to smokers, I
think it’s a no-brainer. Cigarettes shorten your life
significantly, and quitting makes a big difference in how much your
life is shortened. It’s in the context of how dangerous
cigarettes are that it becomes easy for me to say, “Smokers,
if you can use [e-cigarettes] as a tool to quit, do it. Start
today.”

Gary Giovino: I have a nephew who smoked and he switched
to e-cigarettes, and people would say to him, “Are you
kidding yourself? These things are no better.” I just find
that ridiculous. There are a small number of chemicals at very low
concentrations in e-cigs compared to the hundreds of toxic and
carcinogenic chemicals concentrated in tobacco smoke.

LK: For somebody to say e-cigarettes are just as bad is a
very harm-causing statement. The evidence base for that is
nonexistent. Can you find things that would be of concern in them?
Yes. Do they approach cigarettes in risk? Not even close.

GG: People oppose them partly because of the way
they’re marketed and partly because the big tobacco companies
are getting involved in the business. In some ways, the marketing
is similar to how they used to market tobacco cigarettes decades
ago. That is offputting to a lot of people, myself included. If I
had my way, they would be marketed as a way for smokers to get off
the extremely dangerous products—combusted cigarettes and
cigars. The companies that are making e-cigarettes are not making
it easy for people who really care about health to be supporters of
them.

LK: There’s a conflict in that one of the reasons
the products have been so successful is that they haven’t
been marketed as a smoking-cessation device. They’re a fun
thing to do. If you market it as a product that’s fun to use,
you’re likely to get more penetration in the market, but
you’re also likely to attract some new users to the product
rather than, “OK, you can only use this if you smoke
cigarettes and we want you to quit.”

GG: The youth issue is a bit of a game-changer for me.
Part of the logic of people who oppose e-cigarettes is that if kids
are using these products, then they must be bad. I don’t have
a problem if a kid who was going to smoke tobacco cigarettes
instead uses an e-cigarette. I do have a problem if a kid who never
would have started on tobacco cigarettes starts with e-cigarettes
and then converts to smoking tobacco. That’s the scenario
that scares me. Another issue is flavorings. They put a lot of
flavorings in e-cigarettes, and we know that younger people prefer
flavored tobacco products.

LK: I agree that’s a valid issue, but it
doesn’t take away from the bigger point. From a public health
point of view, cigarettes are a gigantic challenge. If all
cigarette use was converted to a well-regulated vaping product that
minimized risk, the government wouldn’t have an office
focused on the health issues with these. They’d be more
concerned with alcohol, for example—any number of things. In
the public health business, you can’t be thinking of living
in an imaginary world where there’s no risk. Take the risk of
bicycle riding. Helmet wearing reduces it but it only reduces it.
There’s still a risk. It’s not safe.

GG: Every prescription drug carries a risk. Nothing is
risk-free.

LK: I’ve had colleagues in public health who would
not make a public professional statement that you should switch to
[e-cigarettes] because they would be better for you, but they would
tell their loved ones to. I wrote a piece in the Huffington
Post out of the conviction that smokers needed to know about
e-cigarettes ASAP, and that to sit on what was, in a sense, clearly
known would have been irresponsible. Based on the evidence
I’ve seen, it would probably be desirable to have some
restrictions on flavorings, but that doesn’t make me want to
say I’m going to withdraw my Huffington Post position until
we get this flavor matter sorted out.

GG: Stay tuned. We’re working on papers and the
reality is, you’ve got to get them out fast, because as these
products bloom, the research on them is also exploding.
There’s a ton of work being done on this right now.
Hopefully, the research will help the government to get it
right.